Vitamin D and autoimmune dermatoses: A review
Keywords:
Vitamin D, vitamin D receptor, psoriasis, autoimmune bullous, vitiligoAbstract
 Historically, vitamin D was associated with rickets and osteomalacia. Recent evidence demonstrates that vitamin D is crucial in influencing general health and the immune system. Vitamin D has been associated as a natural immunomodulator through its strong association between vitamin D signaling and immune response regulation, both cellular and humoral. The hypothesis of a disease-specific alteration of vitamin D metabolism, including various autoimmune diseases, further reinforces vitamin D’s role in maintaining a balanced immune system. The pathogenesis of many skin diseases, specifically autoimmune dermatoses, is also associated with disturbance in immune system regulation. Administration of vitamin D or its analogues is the therapeutic choice for the treatment of several skin diseases. This review summarizes recent epidemiological and experimental studies on vitamin D involvement in autoimmune dermatoses, specifically psoriasis, autoimmune bullous disease (pemphigus vulgaris and bullous pemphigoid), and vitiligo. ÂReferences
Agmon-Levin N, Theodor E, Segal RM, Shoenfeld Y. Vitamin D in systemic and organ-specific autoimmune diseases. Clin Rev Allergy Immunol. 2013;45(2):256–66.
Bergqvist C, Ezzedine K. Vitamin D and the skin: What should a dermatologist know? G Ital di Dermatologia e Venereol. 2019;154(6):669–80.
Borel P, Caillaud D, Cano NJ. Vitamin D bioavailability: State of the art. Crit Rev Food Sci Nutr. 2021;55(9):1193–205.
Kechichian E, Ezzedine K. Vitamin D and the skin: An update for dermatologists. Am J Clin Dermatol. 2018;19(2):223–35.
Chang SW, Lee HC. Vitamin D and health - The missing vitamin in humans. Pediatr Neonatol. 2019;60(3):237–44.
Ao T, Kikuta J, Ishii M. The effects of vitamin D on immune system and inflammatory diseases. Biomolecules. 2021;11(11):1–9.
Carlberg C. Nutrigenomics of vitamin D. Nutrients. 2019;11(3):676.
Wadhwa B, Relhan V, Goel K, Kochhar A, Garg V. Vitamin D and skin diseases: A review. Indian J Dermatol Venereol Leprol. 2015;81(4):344–55.
Umar M, Sastry KS, Al Ali F, Al-Khulaifi M, Wang E, Chouchane AI. Vitamin D and the pathophysiology of inflammatory skin diseases. Skin Pharmacol Physiol. 2018;31(2):74–86.
Al Dekwer S, Goncalves-Mendes N, Bingula R, Martinroche G, Lanchais K, Rougé S, et al. 25-Hydroxyvitamin D potentializes extracellular cathelicidin release from human PBMC stimulated ex vivo with either bacterial (LPS) or viral (P: IC) mimetics. J Physiol Biochem. 2022;78(2):335-42.
Mostafa WZ, Hegazy RA. Vitamin D and the skin: Focus on a complex relationship: A review. J Adv Res. 2013;6(6):793–804.
Samanta S. Vitamin D and immunomodulation in the skin: a useful affirmative nexus. Explor Immunol. 2021;1;90–111.
Chen L, Eapen MS, Zosky GR. Vitamin D both facilitates and attenuates the cellular response to lipopolysaccharide. Sci Rep. 2017;7:1–8.
Ismailova A, White JH. Vitamin D, infections and immunity. Rev Endocr Metab Disord. 2022;23:265-77.
Martens PJ, Gysemans C, Verstuyf A, Mathieu CA. Vitamin D’s effect on immune Function. Nutrients. 2020;12(5):1248.
Giannini S, Giusti A, Minisola S, Napoli N, Passeri G, Rossini M, et al. The Immunologic Profile of Vitamin D and Its Role in Different Immune-Mediated Diseases: An Expert Opinion. Nutrients. 2022;14(3):473.
Fabbri A, Infante M, Ricordi C. Editorial - Vitamin D status: a key modulator of innate immunity and natural defense from acute viral respiratory infections. Eur Rev Med Pharmacol Sci. 2020;24(7):4048–52.
Prietl B, Treiber G, Pieber TR, Amrein K. Vitamin D and immune function. Nutrients. 2013;5(7):2502–21.
Rolf L, Muris AH, Hupperts R, Damoiseaux J. Illuminating vitamin D effects on B cells - the multiple sclerosis perspective. Immunology. 2016;147(3):275–84.
Wei R, Christakos S. Mechanisms underlying the regulation of innate and adaptive immunity by vitamin D. Nutrients. 2015;7(10):8251–60.
Xia Y, Chen H, Xiao H, Yang J, Li Z, Wang Y, et al. Immune regulation mechanism of vitamin D level and IL‑17/IL‑17R pathway in Crohn’s disease. Exp Ther Med. 2019;17(5):3423–8.
Ghorbani Z, Rafiee P, Haghighi S, Razeghi Jahromi S, Djalali M, Moradi-Tabriz H, et al. The effects of vitamin D3 supplementation on TGF-β and IL-17 serum levels in migraineurs: post hoc analysis of a randomized clinical trial. J Pharm Heal Care Sci. 2021;7(1):1–9.
Bruce D, Yu S, Ooi JH, Cantorna MT. Converging pathways lead to overproduction of IL-17 in the absence of vitamin D signaling. Int Immunol. 2011;23(8):519–28.
Joshi S, Pantalena L-C, Liu XK, Gaffen SL, Liu H, Rohowsky-Kochan C, et al. 1,25-dihydroxyvitamin D3 ameliorates Th17 autoimmunity via transcriptional modulation of interleukin-17A. Mol Cell Biol. 2011;31(17):3653–69.
Cyprian F, Lefkou E, Varoudi K, Girardi G. Immunomodulatory effects of vitamin D in pregnancy and beyond. Front Immunol. 2019;10:1–17.
Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, et al. Fitzpatrick's Dermatology. 9th edn. New York (USA): McGraw Hill; 2019.
Armstrong AW, Read C. Pathophysiology, clinical presentation, and treatment of psoriasis: A review. J Am Med Assoc. 2020;323(19):1945–60.
Stanescu AMA, Simionescu AA, Diaconu CC. Oral vitamin D therapy in patients with psoriasis. Nutrients. 2021;13(1):1–12.
Bilovol AM, Tkachenko SH, Havryliuk O, Berehova A, Kolhanova NL, Kashtan KP. Possible role of vitamin d in pathogenesis of lichenoid dermatoses (a review of literature). Wiad Lek. 2020;73(2):365–9.
Soleymani T, Hung T, Soung J. The role of vitamin D in psoriasis: A review. Int J Dermatol. 2015;54(4):383–92.
Sheary B. Steroid withdrawal effects following long-term topical corticosteroid use. Dermatitis. 2018;29(4):213–8.
Peric M, Koglin S, Dombrowski Y, Groß K, Bradac E, Büchau A, et al. Vitamin D analogs differentially control antimicrobial peptide "alarmin" expression in psoriasis. PLoS One. 2009;4(7):1–10.
Ingram MA, Jones MB, Stonehouse W, Jarrett P, Scragg R, Mugridge O, et al. Oral vitamin D3 supplementation for chronic plaque psoriasis: a randomized, double-blind, placebo-controlled trial. J Dermatolog Treat. 2018;29(7):648–57.
Zuccotti E, Oliveri M, Girometta C, Ratto D, Di Iorio C, Occhinegro A, et al. Nutritional strategies for psoriasis: Current scientific evidence in clinical trials. Eur Rev Med Pharmacol Sci. 2018;22(23):8537–51.
Fernandes A, Listiawan MY, Ervianti E, Setyaningrum T. The Analysis of serum vitamin D (25[OH]D) level in psoriasis patients comparing with control subjects. BIKKK, Berkala Ilmu Kesehatan Kulit dan Kelamin Periodical of Dermatology and Venereology. 2020;32(2):111–8.
Richetta AG, Silvestri V, Giancristoforo S, Rizzolo P, D’Epiro S, Graziano V, et al. A-1012G promoter polymorphism of vitamin D receptor gene is associated with psoriasis risk and lower allele-specific expression. DNA Cell Biol. 2014;33(2):102–9.
Lesiak A, Wódz K, Ciazynska M, Skibinska M, Waszczykowski M, Ciazynski K, et al. TaaI/Cdx-2 AA variant of VDR defines the response to phototherapy amongst patients with psoriasis. Life (Basel). 2021;11(6):1–14.
Lee YH. Vitamin D receptor ApaI, TaqI, BsmI, and FokI polymorphisms and psoriasis susceptibility: An updated meta-analysis. Clin Exp Dermatol. 2019;44(5):498–505.
Lo Schiavo A, Ruocco E, Brancaccio G, Caccavale S, Ruocco V, Wolf R. Bullous pemphigoid: Etiology, pathogenesis, and inducing factors: Facts and controversies. Clin Dermatol. 2013;31(4):391–9.
Egami S, Yamagami J, Amagai M. Autoimmune bullous skin diseases, pemphigus and pemphigoid. J Allergy Clin Immunol. 2020;145(4):1031–47.
Yang M, Wu H, Zhao M, Long H, Lu Q. Vitamin D status in patients with autoimmune bullous dermatoses: a meta-analysis. J Dermatol Treat. 2022;33(3):1356–67.
Akarsu S, Özbağçivan Ö, Dolaş N, Aktan Ş. Possible triggering factors and comorbidities in newly diagnosed autoimmune bullous diseases. Turkish J Med Sci. 2017;47(3):832–40.
Tukaj S, Grüner D, Tukaj C, Zillikens D, Kasperkiewicz M. Calcitriol exerts anti-inflammatory effects in keratinocytes treated with autoantibodies from a patient with bullous pemphigoid. J Eur Acad Dermatol Venereol. 2016;30(2):288–92.
Tukaj S. Vitamin D in autoimmune bullous disease. Acta Biochim Pol. 2020;67(1):1–5.
Loser K, Beissert S. Regulation of cutaneous immunity by the environment: An important role for UV irradiation and vitamin D. Int Immunopharmacol. 2009;9(5):587–9.
Thankappan A, Sebastian R, Thankappan TP. Vitamin D levels in autoimmune bullous diseases. Int J Contemp Med Res. 2021;8(6):23–5.
Diotallevi F, Campanati A, Martina E, Radi G, Paolinelli M, Marani A, et al. The role of nutrition in immune-mediated, inflammatory skin disease: A narrative review. Nutrients. 2022;14(3):1–20.
Song J, Liu K, Chen W, Liu B, Yang H, Lv L, et al. Circulating vitamin D levels and risk of vitiligo: Evidence from meta-analysis and two-sample mendelian randomization. Front Nutr. 2021;8:1–10.
Varikasuvu SR, Aloori S, Varshney S, Bhongir AV. Decreased circulatory levels of vitamin D in vitiligo: A meta-analysis. An Bras Dermatol. 2021;96(3):284–94.
Iffat H, Yasmeen J.B, Sabhiya M, Peerzada S, Farhan R, Rawoof AM, et al. Association of vitamin D receptor gene polymorphisms and serum 25-hydroxy vitamin D levels in vitiligo – A case-control study. Indian Dermatol Online J. 2019;10:131–58.
AlGhamdi K, Kumar A, Moussa N. The role of vitamin D in melanogenesis with an emphasis on vitiligo. Indian J Dermatol Venereol Leprol. 2013;79(6):750–8.
Sauer B, Ruwisch L, Kleuser B. Antiapoptotic action of 1α,25-dihydroxyvitamin D3 in primary human melanocytes. Melanoma Res. 2003;13(4):339–47.
Kim TE, Kim SK, Shin MK, Jeong KH, Lee MH. Serum 25-hydroxy vitamin D levels and association of vitamin D receptor gene polymorphisms in vitiligo. J Korean Med Sci. 2022;37(14):e110.
Watabe H, Soma Y, Kawa Y, Ito M, Ooka S, Ohsumi K, et al. Differentiation of murine melanocyte precursors induced by 1,25-dihydroxyvitamin D3 is associated with the stimulation of endothelin B receptor expression. J Invest Dermatol. 2002;119(3):583–9.
Youssef YE, Eldegla HEA, Elmekkawy RSM, Gaballah MA. Evaluation of vitamin D receptor gene polymorphisms (ApaI and TaqI) as risk factors of vitiligo and predictors of response to narrowband UVB phototherapy. Arch Dermatol Res. 2022; doi: 10.1007/s00403-022-02348-w. Online ahead of print.
Baysal V, Yildirim M, Erel A, Kesici D. Is the combination of calcipotriol and PUVA effective in vitiligo? J Eur Acad Dermato Venereol. 2003;17(3):299–302.
Yalçin B, Şahin S, Bükülmez G, Karaduman A, Atakan N, Akan T, et al. Experience with calcipotriol as adjunctive treatment for vitiligo in patients who do not respond to PUVA alone: A preliminary study. J Am Acad Dermatol. 2001;44(4):634–7.
Kubelis‑López D, Zapata‑Salazar N, Said‑Fernández S, Sánchez‑DomÃnguez C, Salinas‑Santander M, MartÃnez‑RodrÃguez H, et al. Updates and new medical treatments for vitiligo (Review). Exp Ther Med. 2021;22(2):1–11.
Hu M, Liao K, Lei W, Zhang R, Tu C. The addition of topical calcipotriol to phototherapy enhance the efficacy of treatment in patients with vitiligo: A systematic review and meta-analysis. Int Immunopharmacol. 2021;98(467):107910.